Burns

To distinguish a minor burn from a serious burn, the first step is to determine the degree and extent of damage to body tissue. These three classifications will help you determine emergency care:

First-Degree Burns

The least serious burns are those in which only the outer layer of skin (epidermis) is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin, buttocks, or a major joint.

Second-Degree Burns

When the first layer of skin has been burned through and the second layer of skin (dermis) is also burned, the injury is termed a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling. If the second-degree burn is no larger than two to three inches in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin, buttocks, or is over a major joint, get medical help immediately.

For minor burns - including second-degree burns limited to an area no larger than two to three inches in diameter - take the following action:

Cool the burn. Hold the burned area under cold running water for 15 minutes. If this is impractical, immerse the burn in cold water, or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.

Consider a lotion. Once a burn is completely cooled, apply an aloe vera lotion, triple antibiotic ointment, or a moisturizer to prevent drying and increase comfort.

Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on the burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.

Precautions

Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging the skin.

Don't break blisters. Fluid-filled blisters protect against infection. If blisters break, wash the area with mild soap and water, and then apply an antibiotic ointment and a gauze bandage. Clean and change dressings daily. Antibiotic ointments don't make the burn heal faster, but they can discourage infection. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment. If it's a major burn, don't apply any ointment at all (see below).

Third-Degree Burns

The most serious burns may be painless and involve all layers of the skin. Fat, muscle, and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

For major burns, dial 911. Until an emergency unit arrives, follow these steps:

Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials, or exposed to smoke or heat.

Make sure the burn victim is breathing. If breathing has stopped or you suspect the person's airway is blocked, try to clear the airway and, if necessary, do cardiopulmonary resuscitation (CPR) if trained to do so.

Cover the area of the burn. Use a cool, moist sterile bandage or clean cloth.

Chemical Burns

If chemical burns the skin, follow these steps:

Remove the cause of the burn by flushing chemical(s) off the skin's surface with cool, running water for 20 minutes or more. If the burning chemical is a powder-like substance such as lime, brush it off the skin without exposing yourself before flushing.

Remove clothing or jewelry that has been contaminated by the chemical.

Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.

Rinse the burn again for several more minutes if the victim complains of increased burning after the initial washing. Minor chemical burns usually heal without further treatment.

Seek emergency medical assistance if:

The victim has signs of shock such as fainting, pale complexion, or breathing in a notably shallow manner.

The chemical burned through the first layer of skin and the resulting second-degree burn covers an area more than two to three inches in diameter.

The chemical burn occurred on the eye, hands, feet, face, groin, buttocks, or over a major joint.

If you are unsure whether a substance is toxic, call the poison control center: 800-222-1222. If you seek emergency assistance, bring the chemical container or a complete description of the substance with you for identification.